Document Detail


Lymph-node-first presentation of Kawasaki disease compared with bacterial cervical adenitis and typical Kawasaki disease.
MedLine Citation:
PMID:  23305955     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To identify characteristics differentiating the node-first presentation of Kawasaki disease (NFKD) from bacterial cervical lymphadenitis (BCL) and typical Kawasaki disease (KD).
STUDY DESIGN: From our prospectively collected database, we compared clinical, laboratory, and imaging characteristics of NFKD and BCL cohorts and performed multivariable logistic regression to identify variables that distinguish NFKD from BCL. We then compared outcomes of patients with NFKD and patients with typical KD treated during the same period.
RESULTS: Over 7 years, 57 patients were hospitalized for NFKD, 78 for BCL, and 287 for typical KD. Patients with NFKD were older and had more medical encounters and longer duration of illness before the correct diagnosis was made than did patients with BCL. Of patients with NFKD, 33% had an admission diagnosis of bacterial adenitis or abscess. Compared with patients with BCL, patients with NFKD had lower leukocyte (white blood cell), hemoglobin, and platelet counts and higher absolute band counts (ABCs), C-reactive protein (CRP), alanine transaminase and γ-glutamyl transpeptidase levels, and erythrocyte sedimentation rates. In the multivariable analysis, smaller nodes, lower white blood cell count, and higher ABC and CRP were independently associated with NFKD. Patients with NFKD had multiple enlarged solid nodes and comparable rates of retropharyngeal edema. Compared with patients with typical KD, patients with NFKD were older, had more severe inflammation, and had similar rates of coronary artery abnormalities and resistance to intravenous immune globulin.
CONCLUSIONS: High ABC and CRP values and multiple enlarged solid nodes in febrile patients with cervical adenopathy should prompt consideration of NFKD to prevent delayed diagnosis of KD. Retropharyngeal edema on radiography should not dissuade from the diagnosis of NFKD.
Authors:
John T Kanegaye; Elizabeth Van Cott; Adriana H Tremoulet; Andrea Salgado; Chisato Shimizu; Peter Kruk; John Hauschildt; Xiaoying Sun; Sonia Jain; Jane C Burns
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2013-01-07
Journal Detail:
Title:  The Journal of pediatrics     Volume:  162     ISSN:  1097-6833     ISO Abbreviation:  J. Pediatr.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-27     Completed Date:  2013-08-06     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1259-63, 1263.e1-2     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Mosby, Inc. All rights reserved.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00760435
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MeSH Terms
Descriptor/Qualifier:
Bacterial Infections / complications,  diagnosis*
Child, Preschool
Diagnosis, Differential
Female
Humans
Infant
Lymph Nodes / pathology*
Lymphadenitis / diagnosis*
Male
Mucocutaneous Lymph Node Syndrome / diagnosis*
Prospective Studies
Grant Support
ID/Acronym/Agency:
K24 HL074864/HL/NHLBI NIH HHS; K24-HL074864/HL/NHLBI NIH HHS; R01 HL069413/HL/NHLBI NIH HHS; R01 HL69413/HL/NHLBI NIH HHS
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